特应性家族背景对儿童哮喘急性发作影响

Relationship between atopic family and acute exacerbation in asthmatic chlidren

目的近年来发现部分哮喘急性发作患儿有特应性家族史。本研究探讨特应性家族背景对支气管哮喘儿童急性发作影响。方法选取2014-03-01—2019-02-29漳州市医院儿科收治的218例支气管哮喘急性发作患儿作为研究对象,根据家族特应性背景分为特应性体质组(148例)和非特应性体质组(对照组,70例)。比较两组患儿哮喘急性发作时病情差异,并通过单因素分析及多因素Logistic逐步回归分析探讨特应性家族背景哮喘患儿急性发作危险因素。结果特应性体质组肺功能异常率为84.5%,低于对照组的71.4%,χ2=9.22,P=0.01。特应性体质组危重症率为18.9%,高于对照组的8.6%,χ2=8.55,P=0.04。单因素分析结果显示,季节(χ2=9.19,P=0.03)、早产史(χ2=4.82,P=0.03)、尘螨过敏(χ2=21.91,P<0.01)、支原体(χ2=6.33,P=0.01)、痰培养(χ2=10.86,P<0.01)和人免疫球蛋白E(immunoglobulin E,IgE)水平(t=4.45,P=0.01)为特应性家族背景患儿急性发作的影响因素。多因素Logistic回归分析结果显示,尘螨过敏(OR=6.62,95%CI为2.66~16.47,P<0.01)及血清总IgE水平(OR=1.00,95%CI为1.00~1.00,P=0.03)为特应性家族背景患儿急性发作的危险因素,痰培养阳性(OR=0.15,95%CI为0.04~0.51,P<0.01)为其保护性因素。结论特应性家族背景的哮喘患儿,特别是存在尘螨过敏、高水平血清IgE及痰培养阴性时,更易触发哮喘急性发作,且病情严重。

OBJECTIVE In recent years,it has been found that some children with acute attack of asthma have a family history of atopy.The purpose of this study was to investigate the effect of family background on acute attack of children with asthma.METHODS From March 1,2014 to February 29,2019,a total of 218 children with acute attack of bronchial asthma admitted to Zhangzhou hospital were selected as the study objects.According to the family background,they were divided into the family background group(148 cases)and the family background group(70 cases).The risk factors of acute attack in asthmatic children with special family background were studied by single factor analysis and multi factor logistic stepwise regression analysis.RESULTS The abnormal rate of pulmonary function in the atopic constitution group was 84.5%,lower than 71.4%in the control group,χ~2=9.22,P=0.01.The critical rate of the atopic constitution group was 18.9%,higher than that of the control group(8.6%),χ~2=8.55,P=0.04.Single factor analysis showed that season(χ~2=9.19,P=0.03),history of preterm birth(χ~2=4.82,P=0.03),dust mite allergy(χ~2=21.91,P<0.01),mycoplasma(χ~2=6.33,P=0.01),sputum culture(χ~2=10.86,P<0.01)and IgE level(t=4.45,P=0.01)were the influencing factors of acute attack in children with atopic family background.Multivariate Logistic regression analysis showed that dust mite allergy(OR=6.62,95%CI:2.66-16.47,P<0.01),serum total IgE level(OR=1.00,95%CI:1.00-1.00,P=0.03),sputum culture positive(OR=0.15,95%CI:0.04-0.51,P<0.01)were the influencing factors of acute attack in children with special family background.CONCLUSION Asthmatic children with special family background,especially with dust mite allergy,high level of serum IgE and negative sputum culture are more likely to trigger the acute attack of asthma,and the condition is serious.